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Lawson Road Surgery NHS GP Surgery in Norwich

COPD review

COPD Assessment

Section

How out of breath do you get? *

MRC1: Short of breath only on strenuous exercise

MRC2: Short of breath when hurrying or walking up a slight hill

MRC3: Walks slower than contemporaries on level as breathless or stops if walking own pace

MRC4: Stops for breath after walking 100 yards on level ground or after a few minutes

MRC5: Breathless if dressing or too breathless to leave the house

Assessment

Coughing

Coughing: from 0 (I never cough) to 5 (I cough all the time) *

0

1

2

3

4

5

Phlegm

Phlegm: from 0 (I have no phlegm – mucus – in my chest at all) to 5 (My chest is full of phlegm – mucus) *

0

1

2

3

4

5

Tightness

Tightness: from 0 (My chest does not feel tight at all) to 5 (My chest feels very tight) *

0

1

2

3

4

5

Stairs

Stairs: from 0 (When I walk up a hill or one flight of stairs I am not breathless) to 5 (When I walk up a hill or one flight of stairs I am very breathless) *

0

1

2

3

4

5

Activities

Activities: from 0 (I am not limited doing any activities at home) to 5 (I am very limited doing any activities at home) *

0

1

2

3

4

5

Leaving

Leaving: from 0 (I am confident leaving my home despite my lung condition) to 5 (I am not at all confident leaving my home because of my lung condition) *

0

1

2

3

4

5

Sleep

Sleep: from 0 (I sleep soundly) to 5 (I don’t sleep soundly because of my lung condition) *

0

1

2

3

4

5

Energy

Energy: from 0 (I have lots of energy) to 5 (I have no energy at all) *

0

1

2

3

4

5

How many COPD exacerbations have you had in the past 12 months? An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack or seek medication attention.

Did you go into hospital because of any COPD exacerbations?

Yes

No

Do you smoke?

Yes

No

We strongly advise you to quit smoking. You can get advice on ways to quit smoking and general tips from: www.smokefreenorfolk.nhs.uk or please call 0800 085 4113.

Pulmonary rehabilitation is a treatment programme that can help you stay active if you have a lung condition. It consists of physical exercises and advice from professionals about managing your condition. Have you already completed pulmonary rehab?

Yes

No

Would you like to be referred for pulmonary rehabilitation?

Yes

No

Further information on Pulmonary Rehabilitation can be found below:

Norfolk Community Health and Care: Pulmonary Rehabilitation
BLF: Pulmonary Rehabilitation

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The Health Centre
Lawson Road
Norwich
NR3 4LE

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01603 427096

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